Ever-changing endoscopic treatment for early gastric cancer: Yesterday-today-tomorrow

Figure 1 Features of confocal endomicroscopy. A: Normal gastric epithelium, round pattern of normal crypts is observed; B: Dysplasia, dark epithelium with irregular and varying thickness is observed; C: Differentiated adenocarcinoma, disorganized epithelium with dark and irregular glands is observed; D: Undifferentiated adenocarcinoma, dark and irregular cells with no identifiable glandular structures are observed.

Figure 2 Endoscopic submucosal dissection with sentinel node navigation. A: Marking for endoscopic submucosal dissection is performed around the tumor; B: Indocyanine green is injected into the submucosal layer around the tumor for sentinel node navigation; C: Sentinel node harvest is performed by laparoscopic pick-up biopsy; D: Endoscopic submucosal dissection is performed.

Figure 3 Full-thickness gastric resection. A: An elevated lesion is noted at the lesser curvature of upper body; B: The lesion becomes distinct by chromoendoscopy using acetic acid and indigocarmin; C: For sentinel node navigation, indocyanine green is injected into the submucosal layer after marking around the tumor; D: Endoscopic full-thickness resection is performed after sentinel node harvest and regional lymph node dissection; E: Final resection is performed with laparoscopy; F: Gastric closure is achieved with laparoscopy.